Methods and related compositions for the treatment of cancer

ABSTRACT

A method of treatment and/or prevention of cancer comprises administering agents which cause increased intracellular granularity in cancer cells, at least in an amount sufficient to inhibit proliferation of such cells and preferably in an amount sufficient to lead to cancer cell death. The method is particularly directed to refractory cancer, particularly hormone refractory prostate cancer. The agents identified cause increased intracellular granularity in the cancer cells, and also convert adherent cancer cells to non-adherent cancer cells, leading to cancer cell death. Using the present invention, cancer cells undergo increased intracellular granularity at relatively low agent concentrations, while also inhibiting cell proliferation. Increased concentrations lead to conversion of adherent cancer cells to non-adherent cancer cells, then to cell death. While the exact mechanism of cancer cell degradation and death is not completely understood, the treated cancer cells, including refractory prostate cancer cells, give indications of cell death through an autophagic mechanism. Pharmaceutical compositions related to the presently disclosed methods are also disclosed.

CROSS REFERENCE TO RELATED APPLICATIONS

This application claims priority in U.S. Provisional Patent ApplicationNo. 61/131,015, filed Jun. 5, 2008, which is incorporated by referencein its entirety herein.

FEDERALLY SPONSORED RESEARCH

The present invention was made with government support under Grant No.1U54 MH074425-01PI, awarded by the National Institute of Health. As aresult, the Government has certain rights in the invention.

BACKGROUND OF THE INVENTION

Cancer is a multifaceted disease characterized by an increase in thenumber of abnormal cells derived from a given normal tissue, with thesecells typically invading adjacent tissues, or metastasizing by spreadingthrough the blood to other regions of the body. Cancer typicallyprogresses through a multistep process that begins with minorpreneoplastic changes, which may progress to neoplasia, the neoplasticlesions possibly developing an increasing capacity for invasion, growth,metastasis, and heterogeneity.

There is an enormous variety of cancers, with examples including cancerof the lung, colon, rectum, prostate, breast, brain, and intestine. Theincidence of cancer continues to climb as the general population ages,as new cancers develop, and as susceptible populations grow. Atremendous demand exists for new methods and compositions that can beused to treat patients with cancer.

As a one specific example, most men will in their lifetime experienceproblems that stem from diseases in their prostate. Malignancies of theprostate gland are the most common form of cancer to occur among men inthe United States, affecting over 180,000 men.

Current therapy may involve surgery, chemotherapy, hormonal therapyand/or radiation treatment to eradicate neoplastic cells in a patient.Other therapies involve biological therapy or immunotherapy. All ofthese approaches pose significant drawbacks for the patient. Surgery,for example, may be contraindicated due to the health of a patient ormay be unacceptable to the patient. Additionally, surgery may notcompletely remove neoplastic tissue. Radiation therapy is only effectivewhen the neoplastic tissue exhibits a higher sensitivity to radiationthan normal tissue. Radiation therapy can also often elicit serious sideeffects. Hormonal therapy is rarely given as a single agent. Althoughhormonal therapy can be effective, it is often used to prevent or delayrecurrence of cancer after other treatments have removed the majority ofcancer cells. Biological therapies and immunotherapies are limited innumber and may produce side effects such as rashes or swellings,flu-like symptoms, including fever, chills and fatigue, digestive tractproblems or allergic reactions.

When prostate cancer is diagnosed prior to metastasis, the patient has agreater then 99% chance of survival. The most successful means fortreating prostate cancer at this stage is a radical prostatectomy.Unfortunately, this surgery carries with it the risk of severing nervesand blood vessels associated with sexual organs and the bladder, and canpotentially result in impotency or incontinency. Radiation therapy isyet another commonly used procedure that carries the risk of impotency.Half the patients who undergo radiation therapy for prostate cancerbecome impotent within 2 years of treatment. In addition to the adverseaffects associated with these procedures, they are significantly lesseffective in patients whose cancer has already delocalized ormetastasized on diagnosis. In these cases, patients generally undergoeven more invasive procedures such as hormonal therapy or chemotherapy.Unfortunately, most patients eventually stop responding to hormonaltherapy and the most successful chemotherapeutic, Taxotere, onlyprolongs the life of advanced prostate cancer patients by 2.5 months onaverage.

As another alternative therapeutic, monoclonal antibody (mAb)-basedimmunotherapy has proven clinically beneficial for cancer patients whileallowing them to maintain a good quality of life. These antibodies caneither regulate proliferation of cancer cells through the manipulationof signal transduction, or promote cytotoxicity. Two examples ofFDA-approved mAb-based anticancer drugs are Herceptin and Rituxan(Rituximab), which are currently being used for the treatment of breastcancer and non-Hodgkin's lymphoma, respectively. While there are nomAb-based therapeutics currently available for prostate cancer patients,advanced clinical studies on mAb-based immunotherapy has shown promisefor the treatment of prostate cancer including advanced prostate cancer.Despite the major advantages of mAb-based immunotherapy, there aresignificant pitfalls which may limit its potential. In general,mAb-based therapeutics are highly costly ($70,000 for full course oftreatment of Herceptin), lack oral bioavailability, and can lead tosevere and often fatal side-effects. For example, Herceptin isassociated with heart problems and cannot be administered toapproximately 10% of cancer patients because of heart-relatedcomplications. Rituxan can cause several side-effects which includerenal failure, infections and immune and pulmonary toxicity.

Overall, chemotherapy often has many drawbacks. Many chemotherapeuticagents are toxic to healthy cells, and chemotherapy can causesignificant and dangerous side effects, including severe nausea, bonemarrow depression, and immunosuppression. Additionally, even withadministration of combinations of chemotherapeutic agents, many tumorcells are resistant or develop resistance to the chemotherapeuticagents. In fact, those cells resistant to the particularchemotherapeutic agents used in the treatment protocol often prove to beresistant to other drugs, even if those agents act by a differentmechanism from the drugs used in the specific treatment. This phenomenonis referred to as pleiotropic drug or multidrug resistance. Because ofsuch drug resistance, many cancers prove refractory to standardchemotherapeutic treatment protocols.

For example, while treatments for prostate cancer do exist, over timeprostate cancer can become refractory to the treatments, and oncerefractory, there are few options available for treating advanced,hormone refractory prostate cancer. Consequently, it is of vitalimportance to identify new methods of cancer prevention and treatment,particularly against refractory cancer cells.

SUMMARY OF THE INVENTION

It is an object of the present invention to identify compounds that areuseful in the treatment of cancer.

It is a further object to provide methods of treatment and/or preventionof cancer comprising administering agents which cause increasedintracellular granularity in cancer cells, at least in an amountsufficient to inhibit proliferation of such cells and preferably in anamount sufficient to lead to cancer cell death.

It is yet another object to provide a method of treatment for cancer,including refractory cancer, particularly prostate cancer includinghormone refractory prostate cancer, as well as metastatic prostatecancer by administering agents which cause increased intracellulargranularity in the refractory cancer cells, at least in an amountsufficient to inhibit proliferation of such cells and preferably in anamount sufficient to lead to refractory cancer cell death. This methodmay optionally utilize radiation therapy to treat cancer in combinationwith the agents of the present invention, which also exhibitradiosensitizing activity.

It is another object to provide a method for treating cancer, includingrefractory cancer, particularly prostate cancer including hormonerefractory prostate cancer, as well as metastatic prostate cancer byadministering agents which cause increased intracellular granularity inthe refractory cancer cells, at least in an amount sufficient to inhibitproliferation of such cells and preferably in an amount sufficient tolead to refractory cancer cell death, in combination with one or moresecondary anticancer agents or other agents which are effective intreating cancer, especially prostate cancer, including metastaticprostate cancer as otherwise described herein and further in combinationwith a pharmaceutically acceptable carrier, additive or excipient.Optionally, radiation therapy may be combined with the anticancerincluded in this method to take advantage of the radiosensitizeractivity of anticancer agents of the present invention.

It is still another object of the invention to provide pharmaceuticalcompositions which comprise primary anticancer agents which causeincreased intracellular granularity in cancer cells, especiallyrefractory cancer cells, as otherwise disclosed herein in combinationwith a secondary anticancer agent or other agent which is found to beuseful in treating cancer, especially prostate cancer, includingmetastatic prostate cancer as otherwise described herein and further incombination with a pharmaceutically acceptable carrier, additive orexcipient.

Without being limited by way of theory, [0014] Tthese and other objectsof the present invention are achieved by a method which comprisesadministering to a mammal an effective amount of a composition asotherwise described herein sufficient for increasing the intracellulargranularity of cancer cells, thereby inhibiting cell proliferation andpreferably in an amount sufficient to cause cancer cell death. Inaddition, the inventive method further comprises administering acomposition in an amount effective for converting adherent cancer cellsto non-adherent cancer cells, leading to cancer cell death.

Using the present invention, cancer cells undergo increasedintracellular granularity at relatively low concentrations of theinventive compositions, while also inhibiting cell proliferation.Increased concentrations lead to conversion of adherent cancer cells tonon-adherent cancer cells, then to cell death. While the exact mechanismof cancer cell degradation and death is not completely understood, thetreated cancer cells, including refractory prostate cancer cells, do notproduce indications of apoptotic cell death, but rather give indicationsof cell death through an autophagic mechanism.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows the chemical structure of astemizole (AST), one of thecompounds found useful in accordance with the present invention.

FIGS. 2A and 2B are flow cytometric analyses of prostate cancer cellsused to measure levels of intracellular granularity using side scatter(SSC-H) as an endpoint. Untreated, control cells are shown in FIG. 2Awith low SSC-H levels present in the gated region R1, whereas highintra-cellular granularity is seen in treated cells as shown in FIG. 2B.

FIG. 3 shows 200× phase contrast microscopy images showing increasedintracellular granularity of treated PC3 human prostate cancer cells.

FIG. 4 shows a dose-response for induction of intracellular granularityfollowed by prostate cancer cell death. Cell death is shown circled at10 μM.

FIG. 5 shows cell death measured in CWRv22 and LAPC4 human prostatecancer cell lines using trypan blue uptake and hemacytometry. SCC cellsare a skin cancer cell line that were not killed by treatment with ASTup to 15 μM.

FIG. 6 shows cell death measured in PC3 androgen-independent humanprostate cancer cells using trypan blue uptake and hemacytometry.

FIG. 7 shows a cell growth analysis in multiple prostate cancer celllines treated with astemizole, FIG. 7A with DU145 cells, FIG. 7B withPC3 cells, FIG. 7C with LAPC4 cells, and FIG. 7D with LNCaP cells.

FIG. 8 shows the induction of an LC3 II band in CWRv22 cells by 10 μMastemizole, indicating that autophagy is induced in these cells.

DETAILED DESCRIPTION OF THE INVENTION

The term “cancer” is used throughout the specification to refer to thepathological process that results in the formation and growth of acancerous or malignant neoplasm, i.e., abnormal tissue that grows bycellular proliferation, often more rapidly than normal and continues togrow after the stimuli that initiated the new growth cease. Malignantneoplasms show partial or complete lack of structural organization andfunctional coordination with the normal tissue and most invadesurrounding tissues, metastasize to several sites, and are likely torecur after attempted removal and to cause the death of the patientunless adequately treated.

As used herein, the term “neoplasia” is used to describe all cancerousdisease states and embraces or encompasses the pathological processassociated with malignant hematogenous, ascitic and solid tumors.Representative cancers include, for example, stomach, colon, rectal,liver, pancreatic, lung, breast, cervix uteri, corpus uteri, ovary,prostate, including metastatic prostate cancer, testis, bladder, renal,brain/CNS, head and neck, throat, Hodgkin's disease, non-Hodgkin'slymphoma, multiple myeloma, leukemia, melanoma skin cancer, non-melanomaskin cancer, acute lymphocytic leukemia, acute myelogenous leukemia,Ewing's sarcoma, small cell lung cancer, choriocarcinoma,rhabdomyosarcoma, Wilms' tumor, neuroblastoma, hairy cell leukemia,mouth/pharynx, oesophagus, larynx, kidney cancer and lymphoma, amongothers, which may be treated using the method of the invention,administering one or more compounds in accordance with the presentinvention.

The following terms are used to describe the present invention. Ininstances where a term is not specifically defined herein, that term isgiven an art-recognized meaning by those of ordinary skill applying thatterm in context to its use in describing the present invention.

The term “compound” (also “agent”), as used herein, unless otherwiseindicated, refers to any specific chemical compound disclosed herein andincludes tautomers, regioisomers, geometric isomers, and whereapplicable, optical isomers (enantiomers) thereof, as well aspharmaceutically acceptable salts and alternative pharmaceuticallyacceptable salts (ie., a pharmaceutically acceptable salt formalternative to a pharmaceutically acceptable salt described) andderivatives (including prodrug forms) thereof. Within its use incontext, the term compound generally refers to a single compound, butalso may include other compounds such as stereoisomers, regioisomersand/or optical isomers (including racemic mixtures) as well as specificenantiomers or enantiomerically enriched mixtures of disclosedcompounds. The term also refers, in context to prodrug forms ofcompounds which have been modified to facilitate the administration anddelivery of compounds to a site of activity. It is noted that indescribing the present compounds, numerous substituents, linkers andconnector molecules and variables associated with same, among others,are described. It is understood by those of ordinary skill thatmolecules which are described herein are stable compounds as generallydescribed hereunder.

The term “patient” or “subject” is used throughout the specificationwithin context to describe an animal, generally a mammal and preferablya human, to whom treatment, including prophylactic treatment(prophylaxis), with the compositions according to the present inventionis provided. For treatment of those infections, conditions or diseasestates which are specific for a specific animal such as a human patientor a patient of a particular gender, such as a human male patient, theterm patient refers to that specific animal. Compounds according to thepresent invention are useful for the treatment of cancer, especiallyincluding prostate cancer and in particular, hormone refractory prostatecancer.

The term “effective” is used herein, unless otherwise indicated, todescribe an amount of a compound or composition which, in context, isused to produce or effect an intended result, whether that resultrelates to the inhibition of the effects of a toxicant on a subject orthe treatment of a subject for secondary conditions, disease states ormanifestations of exposure to toxicants as otherwise described herein.This term subsumes all other effective amount or effective concentrationterms (including the term “therapeutically effective”) which areotherwise described in the present application.

The terms “treat”, “treating”, and “treatment”, etc., as used herein,refer to any action providing a benefit to a patient at risk for canceror refractory cancer, including improvement in the condition throughlessening or suppression of at least one symptom, inhibition of cancergrowth, reduction in cancer cells or tissue, prevention or delay inprogression of metastasis of the cancer, prevention or delay in theonset of disease states or conditions which occur secondary to cancer orremission or cure of the cancer, among others.

“Treatment”, as used herein, encompasses both prophylactic andtherapeutic treatment. The term “prophylactic” when used, means toreduce the likelihood of an occurrence or the severity of an occurrencewithin the context of the treatment of cancer, including cancermetastasis as otherwise described hereinabove.

In certain particular aspects of the present invention, the cancer whichis treated is prostate cancer or hormone refractory prostate cancer. Itis understood that metastatic cancer may be found in virtually alltissues of a cancer patient in late stages of the disease, for example,metastatic prostate cancer is found in seminal vesicles, lymphsystem/nodes (lymphoma), in bones, in bladder tissue, in kidney tissue,liver tissue and in virtually any tissue, including brain (braincancer/tumor). Thus, the present invention is generally applicable andmay be used to treat any cancer in any tissue, regardless of etiology.

The term “prostate cancer” is used to describe a disease in which cancerdevelops in the prostate, a gland in the male reproductive system. Itoccurs when cells of the prostate mutate and begin to multiplyuncontrollably. These cells may metastasize (metastatic prostate cancer)from the prostate to virtually any other part of the body, particularlythe bones and lymph nodes, but the kidney, bladder and even the brain,among other tissues. Prostate cancer may cause pain, difficulty inurinating, problems during sexual intercourse, erectile dysfunction.Other symptoms can potentially develop during later stages of thedisease.

For this application, the treatment of hormone-sensitive and hormonerefractory prostate cancer cells in culture are used as examples, theseexamples providing evidence sufficient to support use in the treatmentof other cancers using the method described herein, and further usingthese agents for chemoprevention, which includes treatment for personsin high risk groups, such as those genetically prone to develop cancerand persons that have been exposed to conditions that may promote cancerdevelopment, neo-adjuvant and adjuvant chemotherapy for cancer, andtreatment of all stages of cancer after diagnosis. The method includesuse of the identified agents alone as well as in combination with eachother. Also, the method allows for these agents to be administered incombination with, or as supplements to, other medical treatments. Forexample, they may be used in combination with radiotherapy to increasethe efficiency of cancer treatment.

The use of specific chemotherapeutic regimens for cancer can depend onthe stage of cancer at the time the disease is diagnosed or the state towhich the disease has progressed. For example, the initialchemotherapeutic treatment of prostate cancer is often performed usingdrugs that inhibit androgen production. After 2 to 3 years, prostatecancer becomes refractory to anti-androgen therapy necessitating the useof drugs that non-specifically attack prostate cancer. However, thecurrent treatments for advanced, hormone-refractory prostate cancer donot greatly increase life-span and their actions are largely palliative.Therefore, novel, effective treatments for many cancers, includingrefractory prostate cancer, are desperately needed.

The term “radiation therapy” is used to describe therapy for prostatecancer which may be used in conjunction with the present compounds whichexhibit activity as radiation sensitizers, in addition to their inherentanticancer activity. Radiation therapy uses high doses of radiation,such as X-rays, to destroy cancer cells. The radiation damages thegenetic material of the cells so that they can't grow. Althoughradiation damages normal cells as well as cancer cells, the normal cellscan repair themselves and function, while the cancer cells cannot.

Radiation therapy may be in combination with the presently claimedcompounds, which can function as radiation sensitizers or the therapy(radiation plus compounds of the present invention) may be furthercombined with hormonal treatment and other treatment as otherwisedisclosed herein to treat prostate cancer. Radiation therapy mosteffective in treating cancers that have not spread outside the prostate.But it also may be used if the cancer has spread to nearby tissue.Radiation is sometimes used after surgery to destroy any remainingcancer cells and to relieve pain from metastatic cancer.

Radiation is delivered in one of two ways. External-beam radiationtherapy and branchytherapy. External-beam radiation therapy uses a largemachine to aim a beam of radiation at the tumor. After the area ofcancer is identified, an ink tattoo no bigger than a pencil tip isplaced on the skin of the subject so that the radiation beam can beaimed at the same spot for each treatment. This helps focus the beam onthe cancer to protect nearby healthy tissue from the radiation. Externalradiation treatments usually are done 5 days a week for 4 to 8 weeks. Ifcancer has spread to the patient's bones, shorter periods of treatmentmay be given to specific areas to relieve pain.

There are basically three types of external radiation therapy: conformalradiotherapy (3D-CRT), intensity-modulation radiation therapy (IMRT) andproton therapy. Conformal radiotherapy uses a three-dimensional planningsystem to target a strong dose of radiation to the prostate cancer. Thishelps to protect healthy tissue from radiation. Intensity-modulatedradiation therapy uses a carefully adjusted amount of radiation. Thisprotects healthy tissues more than conformal radiotherapy does. Protontherapy uses a different type of energy (protons) than X-rays. Thisapproach allows a higher amount of specifically directed radiation,which protects nearby healthy tissues the most, especially the rectum.Sometimes proton therapy is combined with X-ray therapy.

Brachytherapy, or internal radiation therapy, uses dozens of tiny seedsthat contain radioactive material. It may be used preferably to treatearly-stage prostate cancer. Needles are used to insert the seedsthrough your skin into your prostate. The surgeon uses ultrasound tolocate your prostate and guide the needles. As the needles are pulledout, the seeds are left in place. The seeds release radiation for weeksor months, after which they are no longer radioactive. The radiation inthe seeds can't be aimed as accurately as external beams, but they areless likely to damage normal tissue. After the seeds have lost theirradioactivity, they become harmless and can stay in place.

Radiation therapy may combine brachytherapy with low-dose externalradiation. In other cases, treatment combines surgery with externalradiation. In the present invention, compounds which are otherwiseclaimed may be used as radiation sensitizers.

The term “coadministration” shall mean that at least two compounds orcompositions are administered to the patient at the same time, such thateffective amounts or concentrations of each of the two or more compoundsmay be found in the patient at a given point in time. Although compoundsaccording to the present invention may be co-administered to a patientat the same time, the term embraces both administration of two or moreagents at the same time or at different times, provided that effectiveconcentrations of all coadministered compounds or compositions are foundin the subject at a given time. Anticancer compounds according to thepresent invention (primary anticancer agents) may be administered withone or more additional (secondary) anti-cancer agents or other agentswhich are used to treat or ameliorate the symptoms of cancer, especiallyprostate cancer, including metastatic prostate cancer. Exemplaryanticancer agents which may be coadministered in combination with one ormore chimeric compounds according to the present invention include, forexample, antimetabolites, inhibitors of topoisomerase I and II,alkylating agents and microtubule inhibitors (e.g., taxol). Specificanticancer compounds for use in the present invention include, forexample, aldesleukin; alemtuzumab; alitretinoin; allopurinol;altretamine; amifostine; anastrozole; arsenic trioxide; asparaginase;BCG Live; bexarotene capsules; bexarotene gel; bleomycin; busulfanintravenous; busulfan oral; calusterone; capecitabine; carboplatin;carmustine; carmustine with Polifeprosan 20 Implant; celecoxib;chlorambucil; cisplatin; cladribine; cyclophosphamide; cytarabine;cytarabine liposomal; dacarbazine; dactinomycin; actinomycin D;Darbepoetin alfa; daunorubicin liposomal; daunorubicin, daunomycin;Denileukin diftitox, dexrazoxane; docetaxel; doxorubicin; doxorubicinliposomal; Dromostanolone propionate; Elliott's B Solution; epirubicin;Epoetin alfa estramustine; etoposide phosphate; etoposide (VP-16);exemestane; Filgrastim; floxuridine (intraarterial); fludarabine;fluorouracil (5-FU); fulvestrant; gemtuzumab ozogamicin; goserelinacetate; hydroxyurea; Ibritumomab Tiuxetan; idarubicin; ifosfamide;imatinib mesylate; Interferon alfa-2a; Interferon alfa-2b; irinotecan;letrozole; leucovorin; levamisole; lomustine (CCNU); meclorethamine(nitrogen mustard); megestrol acetate; melphalan (L-PAM); mercaptopurine(6-MP); mesna; methotrexate; methoxsalen; mitomycin C; mitotane;mitoxantrone; nandrolone phenpropionate; Nofetumomab; LOddC; Oprelvekin;oxaliplatin; paclitaxel; pamidronate; pegademase; Pegaspargase;Pegfilgrastim; pentostatin; pipobroman; plicamycin; mithramycin;porfimer sodium; procarbazine; quinacrine; Rasburicase; Rituximab;Sargramostim; streptozocin; talbuvidine (LDT); talc; tamoxifen;temozolomide; teniposide (VM-26); testolactone; thioguanine (6-TG);thiotepa; topotecan; toremifene; Tositumomab; Trastuzumab; tretinoin(ATRA); Uracil Mustard; valrubicin; valtorcitabine (monoval LDC);vinblastine; vinorelbine; zoledronate; and mixtures thereof, amongothers.

In addition to anticancer agents, a number of other agents may becoadministered with primary anticancer compounds according to thepresent invention in the treatment of cancer, especially prostatecancer, including metastatic prostate cancer. These include activeagents, minerals, vitamins and nutritional supplements which have shownsome efficacy in inhibiting prostate cancer tissue or its growth or areotherwise useful in the treatment of prostate cancer. For example, oneor more of dietary selenium, vitamin E, lycopene, soy foods, vitamin D,green tea (e.g., extract), omega-3 fatty acids and phytoestrogens,including beta-sitosterol, may be utilized in combination with thepresent compounds to treat prostate cancer, especially refractoryprostate cancer and metastatic prostate cancer.

In addition, active agents, other than traditional anticancer agentshave shown some utility in treating prostate cancer. The selectiveestrogen receptor modulator drug toremifene may be used in combinationwith the present compounds to treat cancer, especially prostate cancer,including metastatic prostate cancer. In addition, two medications whichblock the conversion of testosterone to dihydrotestosterone, finasterideand dutasteride, are also useful in the treatment of prostate cancerwhen coadministered with compounds according to the present invention.The phytochemicals indole-3-carbinol and diindolylmethane, may also becoadministered with the present compounds for their effects in treatingprostate cancer. Additional agents which may be combined with compoundsaccording to the present invention include antiandrogens, for example,flutamide, bicalutamide, nilutamide, and cyproterone acetate as well asagents which reduce the production of adrenal androgens (e.g. DHEA),such as ketoconazole and aminoglutethimide. Other active agents whichmay be combined with compounds according to the present inventioninclude, for example, GnRH modulators, including agonists andantagonists. GnRH antagonists suppress the production of LH directly,while GnRH agonists suppress LH through the process of downregulationafter an initial stimulation effect. Abarelix is an example of a GnRHantagonist, while the GnRH agonists include leuprolide, goserelin,triptorelin, and buserelin, among others. These agents may be combinedwith compounds according to the present invention in effective amounts.In addition, abiraterone acetate may also be combined with one or morecompounds according to the present invention in the treatment ofprostate cancer, especially including metastatic prostate cancer.

Other agents which may be combined with one or more compounds accordingto the present invention, include the bisphosphonates such as zoledronicacid, which have been shown to delay skeletal complications such asfractures which occur with patients having metastatic prostate cancer.Alpharadin, another agent, may be combined with compounds according tothe present invention to target bone metastasis. In addition, bone paindue to metastatic prostate cancer may be treated with opioid painrelievers such as morphine and oxycodone, among others, which may becombined with compounds according to the present invention.

Coadministration may also refer to the administration of radiationtherapy in combination with one or more compounds according to thepresent invention which may also serve as radiation sensitizers inaddition to anticancer agents, optionally in combination with anaddition anticancer agent or other agent as described herein which isuseful for treating prostate cancer.

The ability of the agents identified herein, for use in the method ofthe invention, to kill cancer cells was determined by the ability of theagents to induce intracellular granularity. To illustrate the utility ofthese agents, prostate cancer cell lines were used under conditions thatwere optimal for induction of markers of intracellular, secretorygranules. The identification of agents that induce intracellulargranularity in cancer cells as an indicator of agents useful for cancertreatment is entirely novel. High-throughput methods were integrated toefficiently identify chemicals that induce intracellular granularity inprostate cancer cell lines.

Using these methods, the Prestwick chemical library was screened foragents that lead to an increase in intracellular granularity of prostatecancer cells. In addition to detecting increases in intracellulargranularity, this methodology detects cell death by identifyingchemicals that cause the adherent cells in this assay to becomenon-adherent. Multiple chemicals have been identified using thistechnology that are believed to be useful for the prevention andtreatment of cancer.

Table 1 includes those chemicals that increase intracellular granularityleading to cancer cell death. It was determined that after reaching peakconcentrations of these agents for producing intracellular granularity,these chemicals can lead to cancer cell death. Low doses of these agentscause increased intracellular granularity, which ultimately lead cellsto become non-adherent, reducing cell numbers because of cancer celldeath (see FIG. 3). For each of these groups, compounds have beenselected to test to confirm their efficacy. These compounds may becombined for greater efficacy.

TABLE I compounds that increase intracellular granularity and whichcause cancer cell death (primary anti-cancer agents according to thepresent invention): 3-hydroxymethyl-beta-carboline AlbendazoleAlprenolol hydrochloride Ambroxol hydrochloride Amitryptilinehydrochloride Amodiaquin dihydrochloride dihydrate Amoxapine Antazolinehydrochloride Anisomycin Antimycin A Apomorphine hydrochlorideAstemizole Azacyclonol Benperidol Benzethonium chloride Benzydaminehydrochloride Bepridil hydrochloride Bromperidol Cephaelinedihydrochloride heptahydrate Chelidonine monohydrate Chloropyraminehydrochloride Chlorotrianisene Chlorpromazine hydrochlorideChlorprothixene hydrochloride Chrysene-1,4-quinone Clomiphene citrateClomipramine hydrochloride Corticosterone Cyclobenzaprine hydrochlorideCyproheptadine hydrochloride Diaziquone Dibucaine DienestrolDigitoxigenin Digoxin Dihydroergocristine mesylate Dihydroergotoxinemesylate Domperidone Doxepin hydrochloride Emetine dihydrochlorideEpiandrosterone Ethisterone Fenbendazole Fendiline hydrochlorideFluoxetine hydrochloride Fluphenazine dihydrochloride GBR 12909dihydrochloride Gossypol Gramicidin 7-benzyloxy Gramine HaloproginHarmaline hydrochloride dehydrate Hycanthone Ifenprodil tartrateImipramine hydrochloride Ketotifen fumarate Lanatoside C LidoflazineLoperamide hydrochloride Maprotiline hydrochloride MebendazoleMebhydroline 1,5-naphtalenesulfonate Menadione Mesoridazine besylateMetergoline Methimazole Methiothepin maleate Methotrimeprazine maleatesalt Metixene hydrochloride Mycophenolic acid Niclosamide Nitrarinedihydrochloride Nocodazole Norcyclobenzaprine NorethynodrelNortriptyline hydrochloride Parthenolide Perphenazine Pemexiline maleatePimozide Piperlongumine Phenoformin hydrochloride Primaquine diphosphateProchlorperazine dimaleate Propafenone hydrochloride PyrimethamineQuinacrine dihydrochloride dihydrate Quinidine hydrochloride monohydrateRemerine hydrochloride Rescinnamin Securinine Scoulerine Solanine alphaStrophanthidin Suloctidil Tacrine hydrochloride hydrate TerconazoleTerfenadine Thimerosal Thioridazine hydrochloride1-phenyl-3-(2-thiazolyl)-2-Thiourea Triamterene Trifluoperazinedihydrochloride Triflupromazine hydrochloride Trimeprazine tartrateTrimipramine maleate salt Ursolic acid Zimelidine dihydrochloridemonohydrate

One chemical, astemizole (AST), was chosen for more detailed study. ASThas the IUPAC name1-[(4-fluorophenyl)methyl]-N-[1-[2-(4-ethoxyphenyl)ethyl]-piperidyl]benzoimidazol-2-amine,CAS number 68844-77-9, chemical formula C₂₈H₃₁FN₄O, mol. mass 458.571.It was discovered that human cancer cells, as for example prostatecancer cells, cultured with AST at concentrations above 5 μM undergorapid cell death. Previous reports have described the therapeutic valueof AST, but there are no reports of therapeutic value related to cancertreatment.

For example, it is known that AST acts as a histamine H1-receptorantagonist with a long duration of action. In this regard, AST acts tosuppress actions mediated by histamine, such as edema and pruritusmanifesting anticholinergic and antipruritic effects. AST competitivelybinds to histamine H1-receptor sites in the gastrointestinal tract,uterus, blood vessels, and bronchial muscle. Pharmacokinetically, AST israpidly absorbed from the gastrointestinal tract; protein binding isaround 96%. AST does not cross the blood-brain barrier and H1 receptorbinding is mostly in the peripheral rather than central nervous system.There is nothing which would lead one to believe that AST could be aneffective agent for the treatment of cancer.

Materials and Methods

Chemicals: Initial screens were performed using chemicals present in thePrestwick Chemical Library (Illkirch, France). Follow up studies,including those performed with astemizole (Sigma-Aldrich Cat. No.A6424), used chemicals acquired from Sigma-Aldrich Chemical Co. (St.Louis, Mo.), unless specified otherwise. The chemical structure ofastemizole is shown in FIG. 1

Cell Culture: The androgen-sensitive CWRv22 (i.e., 22Rv1) and LNCaP aswell as the androgen-independent DU145 and PC3 human prostate cancercell lines were acquired from American Type Culture Collection(Manassas, Va.). All cell lines were maintained in Dulbecco's modifiedEagle's medium (DMEM; Invitrogen, Carlsbad, Calif.) containing 5%heat-inactivated fetal calf serum (FCS; Sigma, St. Louis, Mo.) withstreptomycin-penicillin antibiotics (designated DMEM/FCS) in a 5% CO₂incubator at 37° C. LAPC4 cells adapted to growth in DMEM and 5% FCSwere acquired from George Wilding (University of Wisconsin, Paul P.Carbone Comprehensive Cancer Center).

Cell Proliferation Assay: To determine the number of proliferating cellsafter astemizole treatment, cells were seeded in 96-well tissue cultureplates at 5,000 cells per well in 100 uL of DMEM/FCS. Two days afterplating, cells were treated with astemizole at the indicatedconcentrations. Four days after treatment, cell proliferation wasdetermined using the CyQUANT NF Cell Proliferation Assay Kit(Invitrogen, Carlsbad, Calif.) according to the kit instructions.

Cell Viability Assays: Two assays were used to determine cell viability;propidium iodide exclusion with flow cytometry and trypan blue exclusionwith hemacytometry. Cells were treated with astemizole at the indicatedconcentrations for 24 to 96 hours prior to viability analysis. Forpropidium iodide cell viability determinations, cells were removed fromthe dishes with 0.05% trypsin. All cell culture medium was collected forthe analysis in order to include any cells that may have released fromthe plate during the incubation period. Propidium iodide was added at afinal concentration of 2 μg/ml and cells were analyzed on a BectonDickinson FACScan flow cytometer. For trypan blue dye exclusion studies,all cell culture medium and cells removed by trypsinization werecollected as above. An aliquot of these cells was re-suspended in 0.4%trypan blue. Both viable and non-viable cell counts were obtained bymanual counting using a hemacytometer and light microscopy.

HyperCyt and High-throughput Data Analysis: The HyperCyt® cytometryanalysis system interfaces a flow cytometer and an autosampler. Whilethe sampling probe moves from well to well, a peristaltic pumpsequentially aspirates a small volume from each well. A bubble of air,created by the continuously running pump, separates samples fromindividual wells. Sample and bubble volumes are determined by the timethe sampling probe is in a well (sip time) or in taking air while movingfrom well to well (up time). HyperCyt® sampling of a single 384-wellplate is completed in less than 15 minutes. This system has beenvalidated using cell-based high-throughput endpoint assays for ligandbinding, surface antigen expression, and immunophenotyping.

The air-bubble separated samples, collected by HyperCyt®, are deliveredcontinuously to the cytometer. The data accumulates as a single,time-resolved file with gaps corresponding to air-bubbles. Both forwardand side light scattering properties of treated LNCaP cells weremeasured using a 488 nm laser. Time-resolved data were analyzed byproprietary software (IDLQuery) set to search for 384 separate dataclusters. Data from negative (0.1% DMSO) replicate wells were pooled andused to set gates that define granularity in vehicle-treated LNCaPcells. Negative control samples were defined as an LNCaP populationwhere 10% of the cells exhibit increased granularity based on sidescatter properties. A gate is set reflecting this distinction that isthen applied to each data cluster. These values are automaticallyexported to a Microsoft Excel spreadsheet template that calculatespercent side scatter shift in individual treated samples.

Microscopic and Flow Cytometric Scatter Analysis: Light microscopyimages of prostate cancer cells in culture were collected using anOlympus IX70 inverted microscope and a 20× objective. Flow cytometricanalysis of forward scatter (FSC) and side scatter (SSC) were preformedusing the UNM Shared Flow Cytometry Resource on a Cytomation Mo Flo, anEpics Elite, a Becton Dickinson FACScan, or a Becton Dickinson FACSCalibur.

Results

High-throughput methods were developed using the HyperCyt system andflow cytometry to efficiently identify agents that induce cancer cellsto express markers of increased intracellular granularity. To achievethis goal, flow cytometry using side-scatter (SSC) as an endpoint is asensitive method to examine cells for levels of intracellulargranularity. Astemizole (AST) was chosen as a representative agent fromTable 1 to characterize more fully for the induction of intraceullargranularity and cancer cell death. Using SSC measured by flow cytometry,astemizole (AST) was found to significantly increase cancer cellintracellular granularity (FIG. 2). The increase in intracellulargranularity in cancer cells can be directly observed in PC3 humanprostate cancer cells by light microscopy (FIG. 3). An increase incancer cell intracellular granularity was found to be a predictivemarker of agents that ultimately result in cancer cell death.

Use of the HyperCyt flow cytometry system allows for the detection ofcell death by identifying compounds that cause adherent cancer cells inthe assay to become non-adherent when they die. This is illustrated inFIG. 4 showing a dose-response for AST-induced increases inintracellular granularity (i.e., up to 3 μM), which is followed by celldeath seen at a dose of 10 μM. The action of AST on cancer cells toinduce intracellular granularity and cell death has not previously beenobserved.

Cell killing is the most important endpoint for agents targeted atcancer treatment. Multiple prostate cancer cell lines were used todetermine cytotoxicity of AST in culture on cancer cells. The action ofAST against the androgen-sensitive LNCaP, LAPC4, and CWRv22 humanprostate cancer cells lines was evaluated and found to show adose-response to cell killing by AST treatment. For example, as shown inFIG. 5, CWRv22 and LAPC4 human prostate cancer cells were treated with6, 10, and 15 μM AST for 24 hours and the number of non-viable cells wasdetermined by trypan blue uptake and hemacytometry. Both CWRv22 andLAPC4 were highly sensitive to AST even at the lowest dose tested of 6μM where 80% of the cells were dead within 24 hours of treatment. Incontrast, skin cancer cells (SCC) were found to be resistant to celldeath by AST treatment (FIG. 5).

In addition to inducing cell death in androgen-sensitive cell linesdescribed above, AST was equally effective at inducing cell death in theandrogen-independent PC3 cell line (FIG. 6). PC3 prostate cancer cellswere evaluated for induction of cell death after treatment with AST at5, 10, and 15 μM for 48 hours (FIG. 6) as measured by trypan blueuptake. In this study, greater than 25% cell death was observed in PC3cells treated with 10 for 48 hours. Importantly, nearly 100% of PC3cells were dead following treatment with 15 μM AST (FIG. 6). ASTinhibited the growth of PC3 cells over a 4 day period at concentrationsas low as 1 uM AST (FIG. 7). The significant reduction in prostatecancer cell growth induced by AST was observed in DU145, LAPC4, andLNCaP human prostate cancer cells (FIG. 7). Therefore, AST was found tobe a potent inhibitor of prostate cancer cell growth among all celllines tested and at higher concentrations, AST treatment resulted inprostate cancer cell death.

Multiple mechanisms could account for the cell death observed in cancercells from treatment with AST. Cell death in PC3 cells occurs within 24hours of treatment but it does not produce hallmarks of apoptotic celldeath, such as the production of a hypodiploid population of cells asmeasured using propidium iodide incorporation and flow cytometry.Intriguingly, CWRv22 prostate cancer cells treated with 10 μM AST for 6hours show an increase in the LC3 II band associated with autophagicpathways (FIG. 8). Thus, administering the agents identified above thatinduce intracellular granularity in cancer cells may produce cell deaththrough an autophagic mechanism.

As to the use of astemizole itself as the agent selected from Table 1,pharmacokinetic studies in man demonstrated that astemizole is rapidlyabsorbed, peak plasma concentrations being attained within 1 to 4 hours.Astemizole is extensively metabolized, and excreted as metaboliteschiefly in the feces. The half-life of the active ingredient isapproximately 1 day and the elimination half-life of the activemetabolites is 10 to 14 days. Astemizole was originally indicated forthe treatment of allergic rhinitis, allergic conjunctivitis and chronicurticaria, though it was removed from the U.S. market in 1999. Morerecently, astemizole has been found to be a potent anti-malarial. Therecommended administration would be in an oral form, such as by way of10 mg tablets, one such administration being of from 1-30 mg per day,depending on the particulars of the patient to whom the dosage would beadministered, more preferably being at from 5-20 mg. per day. Optimalabsorption is achieved when taken on an empty stomach. Althoughoverdoses have been reported with no ill effects, rare cases of seriouslife-threatening cardiovascular adverse events includingQT-prolongation, torsades de pointes, and other ventricular arrhythmiashave been observed in patients exceeding recommended doses ofastemizole. It is believed that similar dosages of the other compoundsfrom Table 1 can be readily determined, the dosage for astemizole beingillustrative thereof.

Compounds according to the present invention may also function asradiosensitizers in addition to their anticancer activity. A study wasperformed showing prostate cancer cell killing actions of astemizole incombination with other therapeutic interventions. Astemizole aloneproduced a decrease in 22Rv1 prostate cancer cell viability with 8 μM 24hours after treatment. In combination with 10 nM docetaxel, 2, 4, and 8μM astemizole showed additive levels of cell killing after 24 hours. Incombination with 10 gray radiation, 2, 4, and 8 μM astemizole showedsynergistic levels of cell killing after 24 hours. The results are setforth in the table presented hereinbelow. These studies show thatastemizole acts as a radiosensitizer making prostate cancer cells moresusceptible to the cell killing effects of ionizing radiation. This istrue of the other agents which are described herein.

TABLE 1 % Viability* [Astemizole] (μM) - Mean (SD) Treatment 0 2 4 8Control 89.7 (2.2) 88.2 (4.9) 90.6 (1.2) 64.3 (8.1) 10 nM docetaxel 80.7(1.7) 71.3^(&) (4.1) 74.4^(&) (4.0) 49.7^(&) (5.5) 10 Gy radiation 69.3(4.2) 63.5^(&) (1.1) 57.4^(#) (2.6) 22.2^(#) (1.2) *Viability in 22Rv1prostate cancer cells determined 24 h after treatment by trypan blueexclusion; n = 3. ^(&)Additive action determined with combinationtherapy. ^(#)Synergistic action determined with combination therapy.

It is noted that, as used in this specification and the appended claims,the singular forms “a,” “an,” and “the,” include plural referents unlessexpressly and unequivocally limited to one referent. Thus, for example,reference to “a cell” includes two or more different cells. As usedherein, the term “include” and its grammatical variants are intended tobe non-limiting, such that recitation of items in a list is not to theexclusion of other like items that can be substituted or other itemsthat can be added to the listed items.

The method of the invention contemplates the administration of an agentwhich causes increased intracellular granularity in cancer cells, atleast in an amount sufficient to inhibit proliferation of such cells andpreferably in an amount sufficient to lead to cancer cell death, butmore preferably as a pharmaceutical composition, which can be formulatedusing know methods to adapt the agent for administration via knownroutes, such as topically, orally, transdermally, rectally, vaginally,parentally, intranasally, intraocularly, intravenously, intramuscularly,intraarterially, intrathecally, intracapsularly, intraorbitally,intracardiacly, intradermally, intraperitoneally, transtracheally,subcutaneously, subcuticularly, intraarticularly, subcapsularly,subarachnoidly, intraspinally, intrasternally or by inhalation. Thus,the compounds according to the invention may be formulated foradministration in any convenient way for use in human or veterinarymedicine, and formulated into pharmaceutically acceptable dosage formssuch as described below or by other conventional methods known to thoseof skill in the art.

The method of the invention thus includes administering pharmaceuticallyacceptable compositions containing a therapeutically effective amount ofan agent which causes increased intracellular granularity in cancercells, which may be one or more of the compounds described above inTable 1, formulated together with one or more pharmaceuticallyacceptable carriers and/or diluents. The pharmaceutical compositions maybe formulated for administration in solid or liquid form, and adaptedfor oral administration, as aqueous or non-aqueous solutions orsuspensions, tablets, boluses, powders, granules, pastes for applicationto the tongue or adapted for parenteral administration by subcutaneous,intramuscular or intravenous injection. Topical applications by way of acream, ointment or spray may be of particular interest in countering theeffects of toxicants, post exposure, as well as formulations that areadministered via inhalation.

The phrase “therapeutically effective amount” as used herein means thatamount of a compound, material, or composition which is effective forproducing a desired therapeutic effect by increasing intracellulargranularity in cancer cells, and/or converting adherent cancer cells tonon-adherent cancer cells, leading to cancer cell death, at least in anamount sufficient to inhibit proliferation of such cells and preferablyin an amount sufficient to lead to cancer cell death in at least asub-population of cells in an animal and thereby blocking the biologicalconsequences of that function in the treated cells, at a reasonablebenefit/risk ratio applicable to any medical treatment.

“Pharmaceutically acceptable” as used herein means that the compound orcomposition is suitable for administration to a subject to achieve thetreatments described herein, without unduly deleterious side effects inlight of the severity of the disease and necessity of the treatment.

The phrase “pharmaceutically acceptable carrier” as used herein means apharmaceutically acceptable material, composition or vehicle, such as aliquid or solid filler, diluent, excipient, solvent or encapsulatingmaterial, involved in carrying or transporting the subject antagonistsfrom one organ, or portion of the body, to another organ, or portion ofthe body. Each carrier must be “acceptable” in the sense of beingcompatible with the other ingredients of the formulation and notinjurious to the patient.

It should be understood that various additives, such as wetting agents,emulsifiers and lubricants, as well as coloring agents, release agents,coating agents, sweetening, flavoring and perfuming agents,preservatives and antioxidants can also be present in the compositionsadministered according to the present invention.

Formulations of the invention suitable for oral administration may be inthe form of capsules, cachets, pills, tablets, lozenges, powders,granules, or as a solution or a suspension in an aqueous or non-aqueousliquid, or as an oil-in-water or water-in-oil liquid emulsion, or as anelixir or syrup, or as pastilles and/or as mouth washes and the like,each containing a predetermined amount of the agent which causesincreased intracellular granularity in cancer cells, at least in anamount sufficient to inhibit proliferation of such cells and preferablyin an amount sufficient to lead to cancer cell death, as an activeingredient. Of course, the composition can be formulated so as toprovide slow or controlled release of the active ingredient using knownpharmacological procedures, such as, for example, hydroxypropylmethylcellulose in varying proportions to provide the desired release profile.

Topical or transdermal administration may be by way of applying powders,sprays, ointments, pastes, creams, lotions, gels, solutions, patches andinhalants. The active compound may be mixed under sterile conditionswith a pharmaceutically acceptable carrier, and with any preservatives,buffers, or propellants that may be required. Ophthalmic formulations inthe form of eye ointments, powders, solutions and the like, may also beused in the method of the invention.

The method of the invention contemplates the administration of the agentwhich causes increased intracellular granularity in cancer cells as theactive ingredient, as pharmaceuticals to humans and animals,administered per se or as a pharmaceutical composition containing, forexample, 0.1 to 99.5% (more preferably, 0.5 to 90%) of the activeingredient in combination with a pharmaceutically acceptable carrier.Actual dosage levels of the active ingredient may be varied so as toobtain an amount of the active ingredient that is effective to achievethe desired therapeutic response from an individual patient, and giventhe choice of agent, mode of administration, etc.

The actual dosage depends upon a variety of factors including theactivity of the particular compound of the present invention employed,or the ester, salt or amide thereof, the route of administration, thetime of administration, the rate of excretion of the particular compoundbeing employed, the duration of the treatment, other drugs, compoundsand/or materials used in combination with the particular compoundemployed, the age, sex, weight, condition, general health and priormedical history of the patient being treated, and like factors wellknown in the medical arts, and it is within the ordinary skill of aphysician to determine the effective dose.

In general, a suitable daily dose of a compound of the invention will bethat amount of the compound that is the lowest dose effective to producea therapeutic effect. Such an effective dose will generally depend uponthe factors described above. Generally, doses will range from about0.0001 to about 100 mg per kilogram of body weight per day.

The patient receiving this treatment is any animal in need, includingprimates, in particular humans, and other mammals such as equines,cattle, swine and sheep; and poultry and pets in general.

“Treat”, “treating”, and “treatment”, etc., as used herein, refer to anyaction providing a benefit to a patient at risk for or afflicted bycancer, including improvement in the condition through lessening orsuppression of at least one symptom, delay in progression of the effectsof the cancer, prevention or delay in the onset of the effects of thecancer, etc. Treatment, as used herein, encompasses both prophylacticand therapeutic treatment.

As discussed above, for example, the agents which cause increasedintracellular granularity in cancer cells, at least in an amountsufficient to inhibit proliferation of such cells and preferably in anamount sufficient to lead to cancer cell death, and so can beadministered prophylactically to a mammal in advance of the initiationor proliferation of such cancer. Prophylactic administration iseffective to decrease the likelihood of the occurrence of disease in themammal.

It will be apparent to those skilled in the art that variousmodifications and variations can be made in the devices and methods ofthe present disclosure. Other embodiments of the disclosure will beapparent to those skilled in the art from consideration of thespecification and practice of the embodiments disclosed herein. It isintended that the specification and examples be considered as exemplaryonly.

The complete disclosure of all patents, patent applications, andpublications, and electronically available material cited herein areincorporated by reference. Any inconsistency between the materialincorporated by reference and the material set for in the specificationas originally filed shall be resolved in favor of the specification asoriginally filed. The foregoing detailed description and examples havebeen given for clarity of understanding only. No unnecessary limitationsare to be understood therefrom. The invention is not limited to theexact details shown and described, for variations obvious to one skilledin the art will be included within the invention defined by the claims.

All headings are for the convenience of the reader and should not beused to limit the meaning of the text that follows the heading, unlessso specified.

1-35. (canceled)
 36. A method of treating cancer in a human patient inneed comprising administering to said patient an effective amount of acomposition comprising nortriptyline, securinine, a pharmaceuticallyacceptable salt thereof or a mixture thereof, optionally in combinationwith at least one secondary anticancer agent.
 37. The method accordingto claim 36 wherein said pharmaceutically acceptable salt ofnortriptyline salt is nortriptyline hydrochloride or an alternativepharmaceutical salt of nortryptiline.
 38. The method according to claim36 wherein said composition comprises securinine.
 39. The methodaccording to claim 36 wherein said composition is coadministered with aneffective amount of at least one secondary anticancer agent.
 40. Themethod according to claim 39 wherein said secondary anticancer agent isaldesleukin; alemtuzumab; alitretinoin; allopurinol; altretamine;amifostine; anastrozole; arsenic trioxide; asparaginase; BCG Live;bexarotene capsules; bexarotene gel; bleomycin; busulfan intravenous;busulfan oral; calusterone; capecitabine; carboplatin; carmustine;carmustine with Polifeprosan 20 Implant; celecoxib; chlorambucil;cisplatin; cladribine; cyclophosphamide; cytarabine; cytarabineliposomal; dacarbazine; dactinomycin; actinomycin D; Darbepoetin alfa;daunorubicin liposomal; daunorubicin, daunomycin; Denileukin diftitox,dexrazoxane; docetaxel; doxorubicin; doxorubicin liposomal;Dromostanolone propionate; Elliott's B Solution; epirubicin; Epoetinalfa estramustine; etoposide phosphate; etoposide (VP-16); exemestane;Filgrastim; floxuridine (intraarterial); fludarabine; fluorouracil(5-FU); fulvestrant; gemtuzumab ozogamicin; goserelin acetate;hydroxyurea; Ibritumomab Tiuxetan; idarubicin; ifosfamide; imatinibmesylate; Interferon alfa-2a; Interferon alfa-2b; irinotecan; letrozole;leucovorin; levamisole; lomustine (CCNU); meclorethamine (nitrogenmustard); megestrol acetate; melphalan (L-PAM); mercaptopurine (6-MP);mesna; methotrexate; methoxsalen; mitomycin C; mitotane; mitoxantrone;nandrolone phenpropionate; Nofetumomab; LOddC; Oprelvekin; oxaliplatin;paclitaxel; pamidronate; pegademase; Pegaspargase; Pegfilgrastim;pentostatin; pipobroman; plicamycin; mithramycin; porfimer sodium;procarbazine; quinacrine; Rasburicase; Rituximab; Sargramostim;streptozocin; talbuvidine (LDT); talc; tamoxifen; temozolomide;teniposide (VM-26); testolactone; thioguanine (6-TG); thiotepa;topotecan; toremifene; Tositumomab; Trastuzumab; tretinoin (ATRA);Uracil Mustard; valrubicin; valtorcitabine (monoval LDC); vinblastine;vinorelbine; zoledronate; and mixtures thereof.
 41. The method accordingto claim 36 which is used in combination with radiation therapy.
 42. Themethod according to claim 39 which is used in combination with radiationtherapy.
 43. The method according to claim 40 which is used incombination with radiation therapy.
 44. The method according to claim 36wherein said cancer is lung cancer, including small cell lung cancer,breast cancer, colon cancer, rectal cancer, brain/CNS cancer, livercancer, ovarian cancer, pancreatic cancer and prostate cancer.
 45. Themethod according to claim 39 wherein said cancer is lung cancer,including small cell lung cancer, breast cancer, colon cancer, rectalcancer, brain/CNS cancer, liver cancer, ovarian cancer, pancreaticcancer and prostate cancer.
 46. The method according to claim 40 whereinsaid cancer is lung cancer, including small cell lung cancer, breastcancer, colon cancer, rectal cancer, brain/CNS cancer, liver cancer,ovarian cancer, pancreatic cancer and prostate cancer.
 47. The methodaccording to claim 41 wherein said cancer is lung cancer, includingsmall cell lung cancer, breast cancer, colon cancer, rectal cancer,brain/CNS cancer, liver cancer, ovarian cancer, pancreatic cancer andprostate cancer.
 48. The method according to claim 42 wherein saidcancer is lung cancer, including small cell lung cancer, breast cancer,colon cancer, rectal cancer, brain/CNS cancer, liver cancer, ovariancancer, pancreatic cancer and prostate cancer.
 49. The method accordingto claim 43 wherein said cancer is lung cancer, including small celllung cancer, breast cancer, colon cancer, rectal cancer, brain/CNScancer, liver cancer, ovarian cancer, pancreatic cancer and prostatecancer.
 50. The method according to claim 36 wherein said composition isadministered to said patient orally.
 51. The method according to claim36 wherein said composition is administered to said patientintravenously.
 52. The method according to claim 39 wherein saidcomposition is administered to said patient orally.
 53. The methodaccording to claim 39 wherein said composition is administered to saidpatient intravenously.
 54. The method according to claim 44 wherein saidcomposition is administered to said patient orally.
 55. The methodaccording to claim 44 wherein said composition is administered to saidpatient intravenously.